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Premature Ejaculation - Symptoms, Diagnosis & Treatment

Male Reproductive System
Male Reproductive System Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

What is Premature Ejaculation?

Ejaculation is the release of semen from the body. Premature ejaculation (PE) is when ejaculation happens sooner than a man or his partner would like during sex. Occasional PE is also known as rapid ejaculation, premature climax or early ejaculation. PE might not be a cause for worry. It can be frustrating if it makes sex less enjoyable and impacts relationships. But if it happens often and causes problems, your health care provider can help.

In the U.S., about 1 in 3 men 18 to 59 years old have problems with PE. The problem is often thought to be psychological, but biology may also play a role.

How Does Ejaculation Work?

Ejaculation is controlled by the central nervous system. When men are sexually stimulated, signals are sent to your spinal cord and brain. When men reach a certain level of excitement, signals are then sent from your brain to your reproductive organs. This causes semen to be released through the penis (ejaculation).

Ejaculation has 2 phases: emission and expulsion.

Phase 1: Emission

Emission is when sperm moves from the testicles to the prostate and mixes with seminal fluid to make semen. The vasa deferentia are tubes that help move the sperm from the testicles through the prostate to the base of the penis. (When you are talking about just 1 of these tubes, it is called a vas deferens.)

Phase 2: Expulsion

Expulsion is when the muscles at the base of the penis contract. This forces semen out of the penis. Usually, ejaculation and orgasm (climax) happen at the same time. Some men climax without ejaculating. In most cases, erections go away after this step.

Premature Ejaculation and Erectile Dysfunction (ED)

Sometimes PE is a problem for men who have erection problems (erectile dysfunction or ED). This is when men are not able to get or keep an erection that's firm enough for sex. Since an erection goes away after ejaculation, it can be difficult to know if the problem is PE or ED. ED should be treated first. Premature ejaculation may not be a problem once the ED is treated.

Causes

Serotonin

Though the exact cause of PE is not known, serotonin may play a role. Serotonin is a natural substance made by nerves. High amounts of serotonin in the brain increase the time to ejaculation. Low amounts can shorten the time to ejaculation, and lead to PE.

Psychological Issues

Mental health issues can be involvedd in PE such as:

  • temporary depression
  • stress
  • guilt
  • unrealistic expectations about sexual performance
  • history of sexual repression
  • overall lack of confidence
  • relationship problems

Managing emotional problems often helps.

Related Issues

PE and Age

Premature ejaculation can happen at any age. Aging is not a direct cause of PE, though aging does cause changes in erections and ejaculation. For older men, erections may not be as firm or as large. Erections may not last as long before ejaculation occurs. The feeling that ejaculation is about to happen may be shorter. These changes can naturally lead to an older man ejaculating earlier.

PE and Your Partner

With PE, you may feel you lose some of the closeness shared with a sexual partner. You might feel angry, ashamed and upset, and turn away from your partner. Premature ejaculation doesn't only affect you, it also affects your partner. Your partner may be upset with the change in sexual intimacy. PE can cause partners to feel less connected, or feel hurt or distant.

Talking about the problem is an important step. Couples counseling or sex therapy can be helpful. Exercises, such as the squeeze technique, may be helpful for you and your partner to prolong an erection (see the treatment section of this article for details). Most importantly, a couple should learn ways to relax. Worry (such as performance anxiety) only makes PE worse.

Diagnosis

When PE gets in the way of your sexual pleasure, you should see your health care provider. Most often, your health care provider will diagnose PE after a physical exam and talking with you. Some questions he or she may ask are:

  • How often does PE happen?
  • How long have you had this problem?
  • Does this happen with just one partner, or every partner?
  • Does PE happen with every attempt at sex?
  • What type of sexual activity (i.e., foreplay, masturbation, intercourse, use of visual cues, etc.) do you engage in and how often?
  • How has PE affected your sexual activity?
  • How are your personal relationships?
  • Is there anything that makes PE worse or better (i.e., drugs, alcohol, etc.)?

Lab testing is only needed if your health care provider finds something during your physical exam.

Treatment

Psychological therapy, behavioral therapy, and drugs are the main treatments for PE. You can talk with your health care provider to decide what will help. More than one type of treatment may be used at the same time.

Psychological Therapy

Therapy is a way to address the negative feelings and emotions that lead to problems with sexual relationships. Psychological therapy can be used as the only treatment, or it may be used along with medical or behavioral therapy. The goal of therapy is to learn the source of problems and find solutions that may end PE. It can also help couples learn to grow closer. Psychological therapy can help you become less nervous about sexual performance. It can also give you greater sexual confidence and understanding to improve your partner's satisfaction.

Behavioral Therapy

Behavioral therapy uses exercises to help build tolerance to delay ejaculation. The goal is to help you train your body away from Premature ejaculation. Examples include the squeeze method and the stop-start method. Exercises work well, but they may not be a lasting answer. They depend upon your partner's help, which is not always possible.

The Squeeze Method

With this method, your partner stimulates your penis until you are close to ejaculation. When you are close, your partner firmly squeezes your penis so your erection partly goes away. The goal is for you to become aware of the sensations leading to climax. Then you can better control and delay climax on your own.

The Stop-Start Method

In this method your partner stimulates your penis until just before ejaculation. Your partner then stops until the urge to climax lets up. As you regain control, you ask your partner to start stimulating your penis again. This process is repeated 3 times. You ejaculate on the fourth time. You repeat this method 3 times a week with your partner until you have gained more control.

Medical Therapy

No drugs have been approved in the United States to treat PE. Still, there are some drugs and numbing creams or sprays that have been shown to slow ejaculation in men with PE.

Drugs

Doctors noticed that men and women on antidepressants have delayed orgasms. Drugs such as fluoxetine, paroxetine, sertraline and clomipramine affect serotonin levels. Doctors began to use these drugs "off-label" (for a different reason than the drug's original use) to treat PE. If one drug doesn't work, your doctor may have you try a different drug. If the second drug doesn't work, others will not likely help.

Drugs for PE can be taken every day or only before sex. Your health care provider will decide when you should take a drug based on your activity level. The best time to take the drug is not clear. Most doctors suggest from 2 to 6 hours before sex. PE can return if you stop taking these drugs. Most men with PE need to take these drugs on an ongoing basis.

Numbing Creams or Sprays

These creams/sprays are put on the head of the penis about 20 to 30 minutes before sex. If you leave the numbing cream/spray on your penis for longer than suggested, your erection may go away. Also, the numbing cream/spray should not be left on the exposed penis during vaginal sex because it may cause vaginal numbness. Wash the cream off your penis 5 to 10 minutes before sex. Wearing a condom can also help dull sensation.

After Treatment

With the simple techniques listed here, about 95 out of 100 men will recover from PE. There is no way to promise recovery, but learning how to relax helps. If the problem remains, continue to work with your health care provider to find solutions.